ACA 101: What You Need to Know

Friday, March 6, 2015

Share

This session was especially helpful to congressional staff members new to the issue, but is also a useful review for anyone dealing with the Affordable Care Act (ACA). The briefing took place just as the second marketplace enrollment period ended and the Supreme Court heard oral arguments in a case challenging the law’s subsidies.

What are the key provisions of the ACA? How did the ACA extend coverage to the uninsured? How does the ACA impact private and public insurance coverage, marketplaces and employer-sponsored coverage? What is the role for states? What are the requirements on employers and individuals? How was Medicaid changed by the ACA and then the Supreme Court? How is the Children’s Health Insurance Program (CHIP) affected?

KEY BRIEFING POINTS
If you were unable to attend the briefing, here are some key takeaways:

Jennifer Tolbert, director of state health reform, Kaiser Family Foundation
55 percent of uninsured individuals are eligible for Medicaid or subsidized coverage through the marketplace, Jennifer Tolbert stated. But, due to states that chose not to expand Medicaid, 3.7 million individuals fall in the coverage gap without access to either Medicaid or subsidies, she continued.

Sabrina Corlette, research professor and project director at the Center on Health Insurance Reforms, Georgetown University’s Health Policy Institute
Market reforms, financial assistance and the individual mandate comprise the “three essential legs of the Affordable Care Act stool,” Sabrina Corlette stated. A verdict in favor of the plaintiffs in King v. Burwell would remove the financial assistance leg, so that healthier people leave the exchange and those with the greatest health needs, and who are more expensive, would remain, she said.

Paul Fronstin, director of the Health Research and Education Program, Employee Benefit Research Institute
The so-called family glitch may affect 2 million to 4 million people, said Paul Fronstin. Eligibility for subsidies to buy marketplace insurance is based on both income and also access to affordable employer-sponsored insurance. However, the affordability calculation is based on the cost for individual and not family employer coverage, making it impossible for some people to meet the affordability test to qualify for subsidies.

The Cadillac tax addresses high-cost health plans that encourage the use of unnecessary health care services, especially since health benefits in the workplace are not taxed like wages, Paul Fronstin stated. The intent is to reduce these very generous benefits and find a source of revenue to pay for other provisions in the ACA.

Diane Rowland, executive vice president, The Kaiser Family Foundation
The ACA modernized eligibility determinations and the enrollment process for Medicaid, extending it to childless adults without disabilities, Diane Rowland stated. States that expanded Medicaid coverage have seen greater reductions in their uninsured populations, she added.

Diane Rowland of Kaiser co-moderated with Ed Howard of the Alliance.

The event was sponsored by the nonpartisan Alliance for Health Reform and The Henry J. Kaiser Family Foundation.